Nutrition and Physical Activity Clinical Practice Guidelines for Older Adults Living with Frailty.

BACKGROUND

We developed clinical practice guidelines to provide health care providers with evidence-based recommendations for decisions related to the effective management of frailty and pre-frailty using nutrition and physical activity interventions.

METHODS

We based the recommendations on two systematic reviews with meta-analyses. Nutrition, physical activity, and combined nutrition and physical activity interventions for adults ≥65y were considered if study populations were identified as frail using a frailty tool or assessment. Risk of bias and certainty of evidence were evaluated. We included physical outcomes, mobility, frailty, cognitive function, activities of daily living, falls, quality of life, diet quality, energy/fatigue levels, health services use, and caregiver outcomes.

RESULTS

Overall, mobility improvements were moderate with nutritional strategies that optimize dietary intake, various types of physical activity interventions, and interventions that combine nutrition and physical activity. Physical outcomes, such as body mass and muscle strength, improved moderately with nutritional strategies and interventions that combined nutrition with physical activity. Frailty status improved with multi-component physical activity interventions. Strong recommendations include optimizing dietary intake, performing physical activity, and adopting interventions that combine nutrition and physical activity. We strongly recommend various types of physical activity including muscle strengthening activities, mobilization or rehabilitation exercises, and multi-component physical activity interventions.

INTERPRETATION

Tailored nutrition and physical activity interventions based on individual goals and health status are associated with improved clinical and physical outcomes. While the recommendations facilitate shared decision-making, we identified sparse application of validated frailty assessments and lack of standardized research outcomes as critical gaps in knowledge.

Déclaration de conflit d'intérêts

John Muscedere is the Scientific Director of the Canadian Frailty Network, which provided funding for the development of the guidelines. He did not receive payment for work on the guidelines. It is noted that four of the authors are affiliated with one of the funders of the study; however, their involvement helped inform the project design and preparation of the manuscript. CFN was not involved with data extraction or analysis. All screening of articles, data extraction, analysis, and interpretation was conducted by MERST personnel, independent from the Steering Committee or funders. In forming the interdisciplinary Steering Committee and other project team members, CFN collected and reviewed Conflict of Interest forms. Heather Keller receives speaker honoraria, matching research funding, and consultation travel expenses from Abbott Nutrition, as well as speaker honoraria from Nestle Health Sciences. She did not receive payment for any aspect of the submitted work. No other competing interests were declared.